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Primary Care Coding Alert

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What Makes a Clean Claim?

Published on Fri Jan 02, 2004

Question: We are having problems in our family  practice with the number of claims we have had to appeal lately. More often than not, the reason for the denial is our office's insufficient initial reporting. What are the most important things to remember for filing clean claims?

California Subscriber

Answer: Send clean claims the first time by using this checklist to guide your office. Check it before sending every claim to ensure accuracy:
   Make sure the policy number and ID number are accurate.
   Obtain insurance eligibility verification.
   Verify other patient information (proper name, birth date, address, etc.).
   Confirm the info the provider gave you for posting charged entries.
   Check that CPT and ICD-9 codes are up-to-date and as specific as possible.
   Make sure, if applicable, that you have the referral authorization number on the form and, if required, a referring doctor's UPIN or HPI.  
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